Nokea
Considered as the most accessible and convenient method for temperature taking
- A. Oral
- B. Rectal
- C. Tympanic
- D. Axillary
Correct Answer: A
Rationale: Oral temp is most accessible e.g., quick tongue placement needing minimal prep, unlike rectal (invasive), tympanic (equipment), or axillary (longer). Convenient for alert patients, nurses favor it e.g., clinics for routine ease, per practice standards.
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During a physical assessment, a client was diagnosed with increased temperature due to an increased basal metabolic rate (BMR). Which hormonal imbalances may the client have? Select all that apply.
- A. Cortisol
- B. Thyroid
- C. Estrogen
- D. Testosterone
Correct Answer: B
Rationale: Increased BMR with elevated temperature suggests thyroid (B) excess (hyperthyroidism), boosting metabolism. Cortisol (A) affects stress, not BMR primarily. Estrogen (C) and testosterone (D) influence other systems. B is correct. Rationale: Thyroid hormones (T3, T4) directly raise BMR and heat, a classic endocrine imbalance, per physiology, unlike other hormones with indirect effects.
The nurse is caring for an infant with developmental dysplasia of the hip. The nurse should expect to:
- A. Prepare the infant for application of a body cast
- B. Teach the mother to keep the infant in the prone position
- C. Explain that surgery will be necessary within the first 3 months
- D. Tell the mother that the condition will correct itself without treatment
Correct Answer: A
Rationale: For developmental dysplasia of the hip (DDH), a body cast (spica) is often applied to maintain hip alignment, a common intervention post-reduction in infants, guided by orthopedics. Prone positioning, early surgery, or spontaneous correction aren't standard treatment stabilizes the joint. Nurses prepare families for this, explaining its role in preventing long-term disability, ensuring compliance and comfort.
Provides a concise method of organizing and recording data about the client. It is a series of flip cards kept in portable file used in change of shift reports.
- A. Kardex
- B. Progress Notes
- C. SOAPIE
- D. Change of shift report
Correct Answer: A
Rationale: Kardex (A) is a concise, card-based system for shift reports, per nursing practice. Progress notes (B) detail chronologically, SOAPIE (C) structures per problem, shift reports (D) are verbal. A fits the portable file description, making it correct.
The country where SHUSHURUTU originated
- A. China
- B. Egypt
- C. India
- D. Babylonia
Correct Answer: C
Rationale: Shushurutu, an ancient surgical text from India (circa 1000 BCE), details procedures like cataract surgery, rooted in Ayurveda. Unlike China, Egypt, or Babylonia, India's medical tradition birthed this, shaping early knowledge. Nursing traces such origins, as ancient practices inform modern care and historical context.
These are data that are monitored by using graphic charts or graphs that indicated the progression or fluctuation of client's Temperature and Blood pressure.
- A. Progress notes
- B. Kardex
- C. Flow chart
- D. Flow sheet
Correct Answer: D
Rationale: Flow sheets (D) use graphs to track temperature and BP fluctuations, per charting norms. Progress notes (A) narrate, Kardex (B) summarizes, flow charts (C) diagram processes. D matches graphical monitoring, making it correct.